Taking Occupational health to the unorganized sector: Challenges and strategies

Dr. Sylvia Karpagam, Public Health doctor

What is occupational health?• It deals with aspects of health and safety at workplace

• Has a strong focus on prevention of hazards

• Health of workers has several determinants, including risk factors at workplace (e.g. working hours, salary, workplace policies, health promotion and protection provisions of employment and working conditions etc.) leading to accidents, musculoskeletal diseases, respiratory diseases, hearing loss, circulatory diseases, stress related disorders, communicable diseases, cancers and other conditions.

National Policy on Safety, Health and Environment at workplace, Government of India, Ministry of Labour and Economics

• ………without safe, clean environment as well as healthy working conditions, social justice and economic growth cannot be achieved and that safe and healthy working environment is recognized as a fundamental human right.

• The government is committed to • regulate all economic activities for management of safety and health risks at

workplaces • to provide measures so as to ensure safe and healthy working conditions for

every working man and woman in the nation. • Recognizes that safety and health of workers has a positive impact on

productivity and economic and social development.

Then………where do these fit in?

Yakoob Yalakapati

OF DHARWAD TOWN IN KARNATAKA, INDIA - A MUNICIPAL CONTRACT LABOURER DIED WHILE CLEANING A MANHOLE.

Deaths of manual scavengers – not even a statistic or a memory

TWO UNDERAGE UGD LABOURERS RAJESH AND SANTHOSH OF HUBLI TOWN DIED WHILE CLEANING A SOAKPIT

Kutti, Ravi & Babu

MANUAL SCAVENGERS DIED IN KGF, KOLAR WHILE CLEANING A SOAKPIT OF A HOME BELONG TO A CENTRAL GOVERNMENT EMPLOYEE.

Government officials perpetuate the practice

LAKSHMAMMA WORKS AS A MANUAL SCAVENGER AT THE RESIDENCE OF C.M. UDASI WHO IS THE DISTRICT MINISTER OF HAVERI IN KARNATAKASHE THEN CONTINUES THE SAME WORK IN AKKI ALUR RURAL POLICE STATION AND TALUK OFFICE, HAVERI!

Rajappa

WORKS WITH THE HOSPET MUNICIPALITY AS A TEMPORARY UGD LABOURER AND USED TO CLEAN THE UNDERGROUND DRAINAGE SYSTEM LOCATED 5 FEET BENEATH THE EARTH. HE FACES HIGH RISK OF SUFFOCATING ON THE JOB. HIS MONTHLY SALARY IS RS.1800 PER MONTH.

The Bhangis and the Muslims… engaged in manual scavenging in Gulbarga

WOMEN'S BELONGING TO MUSLIM COMMUNITY WERE ACTIVE IN MANUAL SCAVENGING ALONG WITH THEIR MEN IN GULBARGA.

AMIDST THEIR EXTREME POVERTY THESE WOMEN WERE EARNING THEIR DAILY BREAD BY CLEANING THE PITS OF HOTELS, PRIVATE HOMES AND HOSTELS.

State procured Sucking Vehicle

SIDDARAJU OF GULBARGA CORPORATIONS IS A TEMPORARY UGD WORKERHE SAYS THAT THE SCAVENGING MACHINE WHICH COSTS AROUND 8 – 10 LAKHS IS A TOTAL WASTE.IT ONLY SERVES TO DROP THE WORKERS INVOLVED IN SCAVENGING AT THE PLACE OF WORK. HE CLEANS THE UGD CHAMBER REGULARLY WITH HIS HANDS WHILE THE SCAVENGING MACHINE IS PARKED BESIDE HIM.NOTHING HAS CHANGED…………….

Grievious occupational hazards

BABU FROM KGF FELL TO THE GROUND WHEN DIGGING A PIT AT A PRIVATE HOME.HE HAS SUSTAINED SPINAL INJURY BUT HAS NO RECOURSE TO ANY HEALTHCARE. HE HAS NO SOCIAL SECURITY, PENSION OR HEALTH BENEFITS.

Why don’t ‘these people’ stop doing this work??

SOMAPPA OF KOLLEGALA TALUK OF MYSORE DISTRICT HAS LEFT THE PRACTICE OF MANUAL SCAVENGING TO ENSURE DIGNITY FOR HIMSELF AND HIS FAMILY. THE ‘UPPER’ CASTE IN HIS VILLAGE BRIBE THE POLICE TO ENSURE THAT SOMAPPA IS FORCED TO CLEAN THEIR TOILET PITS. THE POLICE USE FORCE AND THREATS TO MAKE SOMAPPA CONTINUE THE PRACTICE.

The reality of the Swach Bharat campaign

THE KARNATAKA STATE GOVERNMENT HAS CLAIMED TO THE HIGH COURT THAT MANUAL SCAVENGING IS NOT BEING PRACTISED IN KARNATAKA. IN AN AFFIDAVIT FOLLOWING A PETITION FILED BY FORMER ADVOCATE GENERAL R N NARASIMHA MURTHY, IT HAS BEEN STATED THAT THE DEPUTY COMMISSIONERS HAD CERTIFIED THAT ALL DRY LATRINES IN RESPECTIVE DISTRICTS HAD BEEN DEMOLISHED.

Occupational health Hazards of street vendors :• Lack of public toilets in several area mean that women do not drink enough water and.this

causes other health issues

• Breathing difficulties because of the pollution in streets

• Mental stress due to uncertainty - although street vending is legal, authorities perceive it to be illegal and vendors are several times under threat of evictions . Even if there is no eviction threat , there is no guarantee that the right to vend will be upheld, so it is a constant fear

• Police violence : In some areas police indulge in violence on Vendors and they get beaten .

• For mobile Vendors who push their carts through traffic, back issues and knee issues are also common as carts are not well designed and it is difficult to navigate through ups and Downs and traffic.

• Absence of good free drinking water also affects their health

Rashtriya Swasthya Bima Yojana

Health and Family Welfare Ministry to Implement RSBY Scheme from Tomorrow

• PM Narendra Modi to launch smart cards for 40 crore unorganised workers !!!!!!!!!!!!!

Experiences of unorganized sector with ‘smart’ card

• Our area leaders asked us to bring all the women from the sangha to the government school. There was a big function and the corporator gave away the cards and we were told that we can use these cards even in private hospitals to get treatment for big health problems I tried taking using it in Bowring a couple of times. They said it is of no use. Now I don’t even know where it is. I am sure it is there somewhere. But why should I bother about it? What use is it to me? When they gave the card they said you could get all the treatment you want for 30000. But when you try to use it, it doesn’t work (Construction worker, interview, Byappanahalli).

• Some people from BJP came and gave the cards. They asked us to bring to the camp our voter ID and coupon card. There were people from Victoria, Bowring and Manipal hospitals. They gave medicines and took photos of family members. Three days later I got a card. They did not take my photo at all. They said my name is not in the list. Only about half the people in this area have got it (FGD with domestic workers in New Byappanhalli).

Experience of the unorganised sector with RSBY• I went to a government hospital, as my husband needed admission. The hospital was

not even aware of this card and asked who had issued it. Then they said they don’t have any insurance scheme with them. (Domestic worker, interview, Jayanagar)

• What use is this card when I go to the neighborhood doctor every other month with body ache, headache, fever, cough and cold? Who will admit me for such problems? I have never used it (Domestic worker, interview, Jayanagar)

•

• On an average I spend Rs.500 to Rs.1000 per visit to a doctor for problems like fever, cough, cold, vomiting and diarrhea. The doctor orders tests and prescribes medicines. This card is of no use for such problems (Construction worker, Byappanahalli)

•

Experience of the unorganised sector with RSBY• ‘When they gave the card they said it would be useful for my family and me. It has

never been of any use. All I can do is see my own face on the card everyday and do pooja to it ‘(Elderly woman, interview, Byappanahalli).

• ‘People have to register their complaint on the web based grievance redressal site. I know it is not a very easy system to use. Even I find it difficult. The concerned person can approach the DKM, the insurance company, the TPA or even the general public and seek their help to register their complaint’. Director, Suvarna Arogya Suraksha Trust

• “Once we took this initiative applications started flowing. But things were not in place. There were frequent transfers of the labor commissioner. 7- 8 commissioners were transferred in a single year. There was absolute chaos. There was no continuity in leadership in the labor department. So those applications are still pending. They are being processed now”. Director, SAST

Experience of the unorganised sector with RSBY• ‘Our long-standing demand has been to extend ESI to all workers in the informal sector.

Be it RSBY or VAS they are all piecemeal and do not provide comprehensive health care. There are more exclusions than inclusions. The ESI model will work best. There are no exclusions and one can avail services from OPD to surgery’. Representative, Construction workers’ Union, Bangalore

• ’In the name of insurance people are being cheated and their money snatched. These schemes have not helped anyone. According to me all these insurance schemes and cards are all bogus. It is a big fraud. These are ways of exploiting the poor and eating money in their name’. Woman, Domestic workers union

• If the government hospitals work well, if doctor is present, examines and treats patients with respect and care and we get tests, treatment and medicines in the government hospital why do we need these schemes? If government hospitals work well, we don’t need insurance and we don’t need schemes and cards. Woman, Construction worker

The construction industry• Construction industry is one of India’s fastest growing sectors and

the second largest generator of employment after agriculture.

• The contribution of construction industry to the Gross Domestic Product (GDP) at factor cost in 2006–07 was `1,965 billion, registering an increase of 10.7 per cent from the previous year.

• ‘The share of construction in GDP has increased from 6.1 per cent in 2002–03 to 6.9 per cent in 2006–07’

(Government of India, 2008a: 239).

Who provides the labour?• Construction industry is attracting huge quantity of unorganised

workers from various parts of the country. This sector is now becoming ‘a way’ of entering a city for the rural migrants

• The employment figures have shown a steady rise from 14.6 million in 1995 to more than double in 2005 that is 31.46 million personnel.

• About 44 per cent of all unorganised urban workers work for India’s booming construction industry (Tiwary & Gangopadhyay, 2011).

The Second National Commission on Labour• considers the working conditions in unorganised sector industries like

underground mines, ship breaking, fireworks and match industry, as dangerous and full of hazards because the workers are very much at risk of losing limbs or lives due to fire, flooding and collapse of roof, emission of (toxic) gases and the failure of ventilation systems in the underground mines.

• The Sengupta Report on Conditions of Work and Promotion of Livelihoods in the Unorganised Sector considers migrant workers as the disadvantaged workers who belong to the bottom layer of the working class in the country.

• Whereas migration is generally considered as an important means of economic redistribution, it can be unproductive for those who are at the bottom of economic and social hierarchy.

Occupation diseases prevalent among the construction workers• Silicosis, lead poisoning, diseases of joints and bones, carbon monoxide, and

benzene poisoning, skin diseases, cancer (among workers exposed to hazards like dust, noise, heat and cold, non-ionizing radiation, cement, glass, adhesives, tar and paint )

• Respiratory, eye and skin disorders, noise-induced hearing loss (NIHL), due to the presence of dust and problem associated with high noise and vibration mostly causes hearing loss and Raynaud’s syndrome

• Cancer, etc, prevalent Injury and accidents with working at heights being the biggest single cause of serious and fatal injuries.

• It is found that in the Indian construction industry, the average Fatal Accident Frequency Rate (FAFR) was 15.8 incidents/1000 employees/year, and construction hazards are rated as eight times more risky as those from the manufacturing sector

• Migrant workers are likely to be victims of fatal accidents due mainly to non-adherence to adequate safety measures. One of the main reasons for the high rate of injuries and large number of occupational diseases is the low level of occupational health services for the workers.

Garment industry• Bangalore – Garment capital of India

• Manufacture for Gap, Levi Strauss, Weil-France, Walt Disney apparels, Tommy Hilfiger, La-coste, Nike, Allen Solly etc.

• Investment in textile industry has grown at CAGR of 32.86% from 2000-2013 in Karnataka

• Textile sector is the second largest employment generating sector in India

Health issues of garment workers• “Pregnant women are given work till term and often given heavy duty work such

as ironing, over locking etc. I am pregnant and due to deliver in three weeks, but when I requested for lighter work, they deliberately gave me heavy work. Now I am doing over-locking and double needle and edge work. At the end of the day, I feel severe pain on the upper part of my abdomen. “Pregnant woman at term, employee of a garment factory.

• “Pregnant women are asked to go to the hospital for check up. The only drugs they have in the factory are Vicks and Moov. There is no cough medicine. For any issues they take ask people to go to ESI. There is no facility for drinking water. There are toilet breaks only at fixed times. There are no chairs for one category of staff (the helpers) and they are expected to stand for 8 hours every day. They are not allowing people with children to join the company since that incident.” GATWU representative in garment factory

Health issues of garment workers• “Breast feeding mothers are not allowed to go and breastfeed their children.” Woman

employee, • “Mother is given the same time to eat and feed children. Many times they feed the

children and skip meals themselves. Although the management had said that they would give an additional 15 minutes to women with children this is being violated. They are given deadliness that they have to meet and therefore the additional 15 minutes is not given to them.” Woman employee

• “Now company takes only children who are above 3 or 4 years. They don’t accept small children into the crèche. They say ‘kaimugithini. Makkalassagavasabeda” (we fold our hands. We don’t want the issues with children).” Woman employee

• “They used very abusing language to the women like bevarsi and loafer.” Woman employee

•

Health issues of garment workers• “Helpers don’t have a chair to sit on and have to remain standing

the entire day.” GATWU representative• “ESI has bad facilities. ESI don’t treat immediately. We go to the

private clinic although we have an ESI card. At ESI they make us wait and we lose and entire day. In the private clinic we can quickly get medicines and go to work if required.” Woman employee,

• “There is no sanitary napkin available in the factory even for sale. Sometimes if women get periods unexpectedly and request for some waste cloth, they are not even provided that.” Woman employee,

Pourakarmika workers• There are over 1.5 lakh pourakarmika workers engaged in cleaning

streets and manholes in Karnataka

• Of whom 95 thousand are under contract basis.

• 90% of the pourakarmikas engaged in sweeping streets are women.

• 90% of male pourakarmika workers are engaged in cleaning drains and manholes

• 95% of pourakarmika workers belong to SC madiga community

Socio-economic status and condition of families• The majority of workers in Karnataka are from Andhra Pradesh.

• Both husband and wife in the family work as pourakarmikas.

• 99% of female and male workers are illiterates.

• Their children are also deprived of education, and a large number of children are school drop-outs, since due to their desperate economic condition, the parents introduce their sons and daughters to cleaning work.

• They do not have any other employable skills than cleaning.

• They live in slums / PK colonies / SC colonies in dilapidated thatched huts / sheet roofs without proper ventilation.

• Often these slums are called unauthorized slums, and hence land ownership is denied to them, and they are deprived of even basic / civic amenities such as drinking water, road, drain, latrine, etc.

Socio-economic situation• The prescribed minimum wage is denied to pourakarmikas who face

harassment by the contractor in various ways (deduction of salary giving various reasons, delay in salary disbursement, too much work load and long hours of work, imposing penalties etc)

• Their salary is not enough to meet the minimum requirement of their families.

• The Supreme Court has observed prevalence of malnutrition among children and women pourakarmika workers.

• Because of lack of alternative skills, they find it difficult to access loans to undertake self employment because of a corrupt system and middlemen’s intervention.

• Often, the girls instead of going to schools are being made to work as caretakers of younger children when the mother goes out for work.

• There are many instances of their sending children for work to supplement family income.

The unorganised sector in India

Laws to “safeguard” the unorganised workers• The Unorganised Workers’ Social Security Act, 2008 (UWSSA) talks about

registration of the unorganised workers for making them eligible for taking benefits of social security

• The Building and Other Construction Workers’ (Regulation of Employment and Conditions of Service) Act, 1996 (BOCWA) also talks about the registration of the construction workers.

• It does not consider any worker as construction worker unless he/she completes 90 days of work in the sector and produces a certificate regarding this. It is practically impossible for any construction worker to produce such certificates. Further, because of their migratory nature, they are even unable to work continuously in one construction site.

The Inter-state Migrant Workmen (Regulation of Employment and Conditions of Service) Act, 1979 (ISMWA)• Defines the duties and the responsibilities of the contractors who engage the inter-state migrant

workers.

• It talks about all the benefits and facilities that the migrant workers should get at the place of work.

• However, despite clear provision of most of the situations related to living conditions, wages and health and injury related risks and threats, very few of the conditions are actually fulfilled in cases of inter-state migrant workers.

• The migratory condition causes loss of all the benefits that they could have got from the government programmes and policies like the Below Poverty Line (BPL) subsidies, ration cards or the health benefits targeted through National Rural Health Mission (NRHM) or other such welfare programmes like Rashtriya Suraksha Bima Yojna (RSBY), Janani Suraksha Yojna (JSY), etc, at their native places.

• Lack of educational facilities around the construction sites deprives the children of the MCWs from getting even primary education and consequent health awareness.

National Sample Survey Organisation (NSSO) in 2009–10• The Indian economy is characterised by the existence of a vast

majority of informal or unorganised labour employment.

• The total employment in the country was of 46.5 crore comprising around 2.8 crore in the organised and the remaining 43.7 crore workers in the unorganised sector.

• Out of these workers in the unorganised sector, there are 24.6 crore workers employed in agricultural sector, about 4.4 crore in construction work and remaining in manufacturing and service.

Sweeping changes in labour laws are taking place in India.• While launching the “Shramyev Jayate” (i.e. only hard work will win)

programme, the Prime Minister urged us to take a compassionate view on “Shram Yogi” (worker) and use them as a source of “Rastra Nirmaata” (nation builder).

• It would therefore appear from this, that the current government is championing the cause of labour.

• Curiously, according to the media reports on the event, the industry lobby (CII, FICCI, ASSOCHAM etc.) unanimously applauded the proposed changes in labour laws, while the central trade unions (including Bharatiya Mazdoor Sangh, the trade union affiliated with the Bharatiya Janata Party [BJP]) complained about not being consulted at all.

Self certification by Manufacturing firms and their Inspection

• “Ease of business is the first and foremost requirement if Make in India has to be made successful” (17 October 2014, The Indian Express).

• A significant move in that direction is the unveiling of Shram Suvidha Portal, which would allow employers to submit a self-certified single compliance report for 16 Central labour laws. This reform is expected to simplify business by putting the onus of compliance with the firms through self-certification. The Prime Minster described this reform as follows: “These facilities are what I call minimum government, maximum governance”. He justified these in the following terms: “Let’s start with trust”. However, self-certification suffers from a basic drawback of non-revelation of truthful information.

Ending the ‘Inspector Raj’• From now on labour inspectors would not be allowed to decide on their own, the establishments

to be inspected. Instead, they would be sent to randomly selected establishments (administered centrally through computerized draw of lot) and have to upload their reports within 72 hours, without future scope of modifying them.

• Even if there are complaints of violation of safety norms by workers, even then labour inspectors might not inspect the offending factories – since now inspection of factories can only be done through random draw of lots.

• Centralized controlling of inspections violates the International Labour Organization’s (ILO) labour inspection convention 81 – to which India is a signatory. This is because according to Article 12 of the labour inspection convention 81, labour inspectors are empowered inter alia, “to enter by day any premises which they may have reasonable cause to believe to be liable to inspection; and to carry out any examination, test or enquiry which they may consider necessary in order to satisfy themselves that the legal provisions are being strictly observed”

• The new stipulation, by regulating inspectors’ visit to establishments curbs the freedom of inspectors to visit any enterprise, thus violating the provisions of ILO convention.

• Cutting down on labour inspections will adversely impact industrial safety, in a country where the culture of adhering to industry safety standards is already abysmal.

• The workers will be at the receiving end of such deteriorating industrial safety norms.

• Introduced at a time when there is clear evidence to show that inspection standards in establishments relating to labour and industrial regulations have declined drastically.

Amendments to labour legislations• Contract Labour Act, 1970 is that it would now be applicable only in case of

establishments employing 50 or more workers instead of the earlier threshold of 20 workers would mean that all regular jobs in establishments below 50 workers (but above 20 workers) would be abolished.

• The Factories Act, 1948 covered those factories employing 10 or more workers (using power) or 20 or more workers (without using power). The recent amendment increased this threshold to 20 workers (using power) and 40 workers (without using power).

• The Industrial Disputes Act (IDA), 1947 previously it was necessary to obtain prior government permission to retrench, layoff workers and closedown factories in an establishment employing 100 or more permanent workers1. The recent amendment raised the employment threshold to 300 workers. In this article we shall comment on each of these labour law changes seriatim.

Make in India……………

• Who does it benefit?• Does it benefit all Indians fairly?• Who pays the price?• Is that price worth paying?• What role does caste and class and privilege

have to play in this?

Progress at what cost?• Whose problem is it?

• Is it a class or caste or human problem?

• Can we claim to be proud Indians in reality?

• What can we do?.